OSTEOPOROSIS: A Silent Disorder

Editor’s note: Home Defense Journal (HDJ) believes that good health and the ability to protect one’s home from external threats are closely interrelated subject matters. HDJ is therefore launching a Health & Fitness Section in order to make for a truly well-rounded on-line publication.

Dr. Ticman, HDJ’s contributor for health, is a noted orthopaedic surgeon, a diplomate of the Philippine Board of Orthopaedics and a fellow of the Philippine Orthopaedic Association. He is also an avid shooter.

By Misael Jonathan A. Ticman, MD, FPOA

BONE HEALTH GURU: Dr. Ticman in a TV grab from the GNN program PracticalBusiness, which is hosted by HDJ editor Miguel Gil.

Osteoporosis is a silent and progressive metabolic bone disorder characterized by low bone mass and weakening of the bone tissue making it fragile and prone to fracture. Under a microscope, a normal bone appears to have an organized formation while on the other hand; an osteoporotic bone has a disorganized appearance.

For years and decades, this disorder can be present without symptoms and patients may not be aware that they have this dreaded condition until they get a bone fractured. Spine is one of the most commonly involved sites. The hips, wrists, and shoulders may also be involved. Spine fractures may cause constricting pain that proceeds in a direct line from the back to the side of the body. Chronic low back pain and loss of height may result from repeated fractures of the spine and this (loss of height) will give the individual a hunched-back appearance of the upper back.

Aside from the spine, osteoporotic hip fractures are also common. These may be caused by trivial accidents. These fractures are responsible for significant pain, poor quality of life, and disability and these patients would most likely need long term nursing-home care. A significant number of postmenopausal women with hip fractures die within one or two years as a direct or as an indirect result of the fracture.

Estrogen, the female hormone, is important in maintaining bone density in women and when they reach menopause, their estrogen levels drop and bone loss accelerates. Studies show that a person’s bone density is at its peak at the age of 15 – 25 years then 0.3 – 0.5% per year is lost thereafter and after menopause, up to 2 – 4% of bone density is lost per year. This means that around 20 – 40% is lost in the first decade after cessation of estrogen activity.

What are the risk factors? There are many risk factors for the development of osteoporosis. Age, female gender, small body frames, cigarette smoking, excessive alcohol consumption, lack of exercise, low calcium diet, vitamin D deficiency, to name a few. Even certain medications and hormonal disorders can cause osteoporosis.

How is osteoprosis diagnosed? A routine radiograph can suggest osteoporosis, however, this is not an accurate indicator of bone density. A Dual Energy X-ray Absorptiometry or DEXA scan is a better diagnostic tool to diagnose this silent disorder. It only takes around five to fifteen minutes to perform this test, it uses very small amount of radiation, and it is quite precise.

Calcium and vitamin D supplements are oftentimes given in combination with pharmacologic agents to treat osteoporosis. However, adequate exercise, proper diet, fall prevention, and smoking cessation are among the mainstays in the prevention of the ill-effects of this malady. One has to bear in mind that prevention of osteoporosis is as important as or even more important than the treatment.